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Respiratory illnesses like asthma are the number one reason why patients come to Children’s of Alabama.  Asthma is an inflammatory lung disease that is very common in children and adults.

Having asthma causes:

  • airway muscles to tighten
  • inflammation to increase
  • swelling in the airways
  • mucus to build up

Airways become swollen, tight and narrow making it hard to breathe.

Common symptoms include:

  • coughing which is often worse at night
  • chest tightness
  • wheezing
  • coughing or difficulty breathing with exercise

In persistent asthma, children have more frequent symptoms and flare-ups.  This is caused by increased airway inflammation, swelling and narrowing that is present every day.

Children with intermittent asthma have few symptoms because they only have rare times of airway swelling and narrowing.

Janet Johnston, CRNP, is a nurse practitioner and asthma educator at Children’s of Alabama.   She said even though there’s no cure for asthma, in most cases families can learn how to make sure their child’s asthma is well controlled.

One of the most important ways to do that is to know the triggers of asthma.

Common triggers are:

  • respiratory infection
  • allergies
  • irritants such as smoke
  • exercise

Oftentimes, just avoiding the triggers can help reduce the occurrence of symptoms.

The exception is exercise. “One trigger you don’t want to avoid is exercise,” she said. “If the child’s asthma is well controlled, they shouldn’t have to avoid exercise.”

Johnston said another concern is making sure the child gets the full dose of medicine through an inhaler alone.  She recommends always using a spacer with the inhaler.

“Using a spacer ensures the proper dose of medicine is going deeply in the child’s lungs,” she said. “It’s important to get the full dose of medicine.  Otherwise, it’s like pouring half of it on the floor.”

Johnston encourages families to have an action plan to help keep their child’s asthma well controlled. The plan should include:

  • seeing the child’s health care provider regularly for asthma
  • having clear instructions about using the inhaler and any other medicine
  • know what to do when symptoms increase
  • know when to call the doctor
  • know when to seek care

Well-controlled asthma means a child is:

  • symptom-free most of the time and not needing frequent quick relief medicine
  • able to play and exercise like other children
  • sleeping through the night
  • not missing school or work due to frequent asthma fare ups


More information about managing asthma is available at

Lake Safety

Alabama is known for its beautiful lakes and enjoying them is a rite of summer.  However, before your family heads to the water, you’ll want to take these precautions to ensure your visit is enjoyable and safe.

Always Wear a Coast Guard Approved Vest

Debbie Coshatt, RN, and nurse educator in Patient Health and Safety at Children’s of Alabama reminds us the importance of being safety conscious at the lake, “Drowning is the second leading cause of death in children,” she says, “Anytime the children are outside, near water, you want to make sure they are wearing a Coast Guard approved life vest.”

Coshatt points out that pool toys like floats and rings are not Coast Guard approved and should not be used; they can give children a false sense of security.  Instead, check your child’s life vest, and be sure it says, “Coast Guard approved” on the tag.

In addition, children should never be left to swim without adult supervision.   Coshatt reminds parents that drowning is often a silent emergency, and that a child can disappear in seconds.

No Diving

Kids and adults often enjoy jumping into a lake, but this can pose a danger because lake water is dark and the floor has different depths, as well as rocks beneath the surface.

For this reason, never dive into a lake head first.  Always jump feet first, and it’s a good idea to know how deep the water is before going in.

Boat Safety

It’s important to obey the law in and around boats as well.  Alabama law states

minors under the age of 16 must wear a life jacket when on a boat.  This law went into effect in 2009 and replaces an older law that required children ages 12 and under to wear a life vest.

In addition, the law states that everyone over the age of 16 must have a life jacket readily accessible and available on any kind of vessel.

Also, make sure the engine and propeller are turned off before getting in and out of a boat. Children should not be operating a boat or Jet Ski at any time.

These other tips will help to keep your family safe on the lake this summer:

  • Don’t let kids swim without adult supervision — lakes or ponds might be shallow near the bank, but increase in depth sharply farther out from shore.
  • Ponds and lakes may hide jagged rocks, broken glass, or trash.
  • Make sure kids wear foot protection; even in the water, they should wear aqua socks or water shoes.
  • Watch out for weeds and grass that could entangle a leg or arm.
  • Most boating accidents, particularly among teens, are related to alcohol. When you and your family are boating, assign a designated driver who won’t drink. Be sure teens know about the dangers of alcohol, on and off the water.

By following these tips, you’ll ensure your trips to the lake are enjoyable and safe for your entire family.

Critical Care Medicine at Children’s

Leslie HayesDr. Leslie Hayes is a certified pediatric critical care physician at Children’s of Alabama and an associate professor of pediatrics in the Division of Pediatric Critical Care at the University of Alabama at Birmingham (UAB) where she trains medical students and doctors in pediatric critical care.

Every year, hundreds of children are admitted to critical care units at Children’s of Alabama. These patients come from within Alabama and from every surrounding state. They come because we offer them a broad variety of life-sustaining care. We see trauma victims and brain injury patients. There are post-operative surgical patients who need close monitoring. And there are premature babies. In fact, if you name a severe, life-threatening illness or condition, we’ve most likely seen it.

Dr. Sam Tilden started critical care services at Children’s in the late 1980s, and now we have one of the busiest critical care systems in the nation for children. We spend a tremendous amount of time and resources ensuring that our critically ill and injured patients are cared for by the best, fully trained health professionals using the most advanced medical technology. We have nine critical care faculty members and another six faculty members just for the cardiac ICU. We train six critical care fellows at a time.

The Children’s Pediatric Intensive Care Unit (PICU), where I spend much of my time, has 22 beds and is located on the seventh floor of the Quarterback Tower in the Benjamin Russell Hospital for Children, and has about 1,400 admissions a year. Nearly all of our critical care patients are in Benjamin Russell Hospital for Children, but the neonatology service additionally has patients at UAB’s Regional Neonatal Intensive Care Unit connected to OB/GYN services at UAB. Children’s has its own 48-bed neonatal intensive care unit, along with a 20-room cardiac intensive care unit and also a burn center that cares more than 170 patients a year. In addition, Children’s operates a 26-bed special care unit, which is a step-down unit for our ICUs.

The PICU handles the greatest variety of patients. Adult intensive care units (ICUs) tend to be subdivided into more specialized units. Our PICU takes patients needing high-level monitoring, intense observation, special procedures and numerous interventions. Patients range in age from birth through young adulthood. Nurses care for one or two patients at a time, depending upon the severity of illness. We welcome and encourage parents to stay with their children.

Education and training are constant and intense. We train fellows, pediatric medical students, nurses and other medical staff. We are dedicated to our trainees. Our aim is to develop leaders and top-notch researchers.

We are strong advocates for continuous quality improvement. We are always looking for ways to improve care. We exchange research with other pediatric hospitals to ensure that we are operating on par with our peers, and staying abreast of new techniques.

Staying on the cutting edge of medical technology is important. It makes caring for patients easier and more effective. For example, we are now using very high quality ultrasound devices while placing central lines in children. That new technology has significantly improved the safety and quality of central line placement. We also have new video devices that we use while performing intubations to place a patient on mechanical ventilation. This device helps us perform that procedure more safely while also allowing trainees to observe the process.

We try to minimize the risks of hospitalization for children by reducing the amount of time they spend in the ICU, and we are good at that. When compared to our peer ICUs across the country, we have shorter lengths of stay. Providing the most effective care in the shortest amount of time helps return children quickly to their optimal state of health.

Unfortunately, when working with critically ill or injured patients, outcomes aren’t always what we’d like. Sometimes all we can do is deliver the safest and highest quality care in the most efficient way. We have to recognize that children sometimes have an illness that we are unable to cure. At those times we have to work in a family-centered way to understand goals of care for that child and work with the family to do all that is possible.

Critical care medicine is extremely difficult work, but it is also personally rewarding.

Teen Driving

When a teen starts to drive, it’s a thrilling time for him or her, but often a terrifying time for mom and dad — and with good reason.  Nearly half a million teens are injured in crashes on American roadways every year and 3,800 die.

Many factors contribute to teen driver crashes. They include driving while using alcohol or drugs and not wearing seat belts.

Kathy Monroe is the medical director of the emergency department at Children’s of Alabama.  Unfortunately she sees first-hand the consequences of teens practicing unsafe behaviors behind the wheel of a car.

“Teen crashes are often caused by poor decisions like not wearing a seatbelt, speeding, or drinking and driving,” she said. “Often crashes happen due to nothing more than inexperience- they run off the edge of the road, they over correct, that leads them to crash into another car.  Inexperience often leads to crashes.”

Often distractions contribute to a crash. These may take the driver’s eyes, ears and attention away from the road. The most common distractions include:

  • Too many passengers in the car
  • Talking on cell phones while driving
  • Texting while driving
  • Eating or drinking while driving
  • Adjusting the radio, CD player, temperature controls, etc.
  • Loud music in the car or wearing headphones

The good news is, studies show that parents can play an important role in encouraging the safety of their teen behind the wheel.

“There’s very good evidence that 1,000 miles of supervised driving with an experienced driver dramatically decreases crash rates for teen drivers,” said Monroe.

She said often parents encourage their teens to practice driving when conditions are favorable, but that’s not preparing them for real life situations. Instead, it’s important that a teen practices driving as frequently as possible in all conditions and multiple scenarios: interstate, backroads, nighttime and rain.

Not only that, remember that whenever you’re behind the wheel, your “driver in training” is watching. “No parent thinks any teen is listening to them,” Monroe said. “And they may or may not be listening but they’re watching, so know your behavior affects their behavior.”

In fact, research shows that teens involved automobile accidents are more likely to have parents who are poor drivers.


Graduated Driver License

One approach that’s been very successful in reducing teen driving accidents is the Alabama Graduated Driver License Law.

The Graduated Driver License contains three components:

  • Curfew
  • Limit of passengers
  • No handheld devices

The Alabama Graduated Driver License Law places restrictions on young drivers to help ensure their safety. Parents should know this law and enforce it with their teen drivers. Your pediatrician can provide a copy of the law to you today or you can visit

Driving is a complex skill that requires education and lots of practice. Parents play a crucial role in teaching their teens to drive safely.

For more on the Graduated Driver License Law and other safety tips for teens and parents click here for our Teen Driving Toolkit:

Lawn Mower Safety

LawnmowerAs you begin assigning chores to your children this summer, there are few things to consider about yard work and lawn mower safety.

“We see quite a few patients in our emergency room during the summer because of lawn mower injuries,” said Dr. Terri Coco, pediatric emergency medicine. “Most typical are skin lacerations and injuries to extremities, such as their hands and feet. We also see some eye injuries when items like rocks or sticks are picked up and thrown by a lawn mower.”

In general, children should be at least:

  • 12 years old to safely operate a walk-behind power or hand lawn mower
  • 16 years old to safely operate a riding lawn mower

When you decide your child is ready to use a lawn mower, spend some time with them reviewing the equipment’s owner manual in advance and talking about how to do the job safely. The most important thing, said Dr. Coco, is parental supervision.

“Lawn mower injuries can be severe. These types of injuries require many surgeries involving many specialists, especially when the goal involves saving a limb,” Dr. Coco said.

Before mowing:

  • Inspect the area to be cut, and remove any items that could be picked up and thrown by the lawn mower.
  • Ensure your lawn equipment is in good working condition.

While mowing:

  • Use sunscreen, safety glasses or goggles, closed-toe shoes and hearing protection.
  • Small children should be a safe distance away while the lawn mower is in use.
  • Never allow children to ride as passengers on a riding lawn mower.
  • Avoid mowing in reverse.
  • Push or drive your mower up and down slopes, not across, to prevent mower rollover.

After mowing:

  • When you turn your mower off, make sure the blades are completely stopped.
  • Only refuel the mower once the engine has cooled.

A lawn mower is a very powerful tool. It can cause serious injuries, but many of these injuries are preventable. Keep your children safe around lawn mowers this summer. Following these guidelines can help prevent lawn mower injuries.

Playground Safety

Children love to play on the playground. Playgrounds offer youngsters an opportunity to be outside, play with friends, and get some exercise. Play is incredibly important to the development of children’s social, emotional, cognitive and physical development, as well as creativity and imagination. But unfortunately, each year, more than 200,000 children are treated at hospital emergency rooms for playground related injuries. Many of these accidents are preventable.

Teri Coco, MD, is a physician in the emergency department at Children’s of Alabama. She says parental supervision is the best way to prevent playground accidents. Adult supervision can help prevent injuries by making sure kids are using playground equipment properly and aren’t engaging in any unsafe behavior on the playground.

“Watch your children. Be aware of where they are, what they’re going down, what their climbing on.”  Playground equipment should be age appropriate. Little ones should play on playgrounds that are designed for their size and abilities. These are usually smaller and are lower to the ground than full- size playgrounds. “You want to watch that what they’re playing on is developmentally appropriate,” Coco said. “So for those children who are less than 2 to 3 years of age, you want to look at that equipment when you get there. Be sure it’s low to the ground, that there are no monkey bars.  The slides should be very low and the surfaces of the equipment should be smooth.”

Small children are also safest if they are playing in their own area, not mixed in with bigger children   who could knock them over. But adult supervision shouldn’t just be limited to the younger children. Older children may test their limits on the playground, so it’s important for parents to keep them in check.

Coco says, the parent should walk around before allowing their children to play on the playground to see that everything is safe. They should check the surface of the playground to be sure there are no exposed nails or twisted metal. Adults should also look for things like broken glass under or around the playground. Coco also recommends feeling the surface of slides to be sure they’re not too hot. The old days of a playground built on top of asphalt or concrete should be over. A hard surface is extremely dangerous in the event of a fall. “The harder the surface is, the more serious the injury is going to be when they fall,” Coco said. Grass, soil and packed earth surfaces are also unsafe and unacceptable because weather and wear can reduce their capability of cushioning a child’s fall. Recommended surfaces include wood chips, mulch, pea gravel or shredded rubber.

Coco said it’s always best for even the older children to avoid more dangerous playground equipment like monkey bars. Parents should also instruct children how to play properly. They should make sure children slide feet-first, not head-first, down slides, and watch that they are using swings properly. They should also make sure children aren’t pushing or rough housing while on the playground.

Parents should encourage their children to play on a playground. Play is an important part of their physical, social, intellectual and emotional development. But it’s important that a parent is always present to watch out for potential dangers and to ensure that their children can play safe.

Dance Medicine is a Growing Specialty at Children’s

Dr. Reed Estes is the Chief of UAB Sports Medicine at Children’s of Alabama and an Assistant Professor at UAB. He treats young athletes, and has developed a growing specialty in dance medicine. He has worked with performers in the Boston Ballet and many other professional and amateur dance companies.

Dance, like any other physical activity, produces its share of injuries, particularly in children Dr. Reed Estes and patientand teenagers. There are sprains, strains, broken bones, bumps and bruises. The more serious injuries often require specialized care and rehabilitation aimed at getting dancers back on their feet and toes. It’s important to understand when and why this specialized care is needed.

Dance injuries account for a steadily increasing volume of my sports medicine practice at Children’s of Alabama. We provide and coordinate care across the many specialties at Children’s, and we work closely with Agile Physical Therapy, which greatly enhances our ability to serve dancers. We conduct clinics at dance studios, and see patients from throughout the southeastern U.S.

Dance injuries are fairly common. On average, 23 children are treated every day in U.S. emergency rooms for some type of dance-related injury, according to a recent study published in the Journal of Physical Activity and Health. That same study also found that the number of serious, dance-related injuries increased 37 percent from 1991 to 2007, climbing from 6,175 to 8,477 annually.

Some dancers come to us just to be checked when approaching a new, more difficult level of performance, such as beginning pre-pointe participation with ballet. Others have been injured, and come to us for specialized care. We understand the mentality of dancers and the things they need to prepare for. It’s considerably different than the way we treat our football players or soccer players.

For example, when a football player tears his anterior cruciate ligament, or ACL, we focus rehabilitation on strengthening his core movements to get him back on the field, specifically to the demands required of a contact athlete. In dance, there are different requirements. A dancer must not only be limber and able to accomplish difficult tasks in an aesthetically pleasing manner, but also maintain full stamina. Rehabilitation for a dancer focuses on that.

Not all injuries require a dance medicine specialist. I tell patients and families to watch for pain that is ongoing, persistent and may be causing disability. Pain that is present with one particular activity, every time it occurs, may indicate a need for medical intervention. Likewise, pain that progresses with a decreasing level of activity often poses a warning sign.

Of course, the best medicine is prevention, and there are things that parents can do with a child who is a dancer. Watch for fatigue, monitor dietary habits, ensure that sleep is sufficient and know when a child or teenager is under stress with projects at school. Understand how that affects them when they are in the dance studio, when they are under duress and fatigued. Young dancers tend to eat poorly and not

get enough sleep before performances when life becomes stressful. There’s only so much time in the day to practice and do homework.

Many times, teenage dancers will remain silent when they are injured. There is often a fear that their instructor may be upset with them, their classmates may lose faith in them, or they may lose their roles in performances. Oftentimes, it requires the parent watching closely and saying, “I noticed my daughter was icing down her ankle or rubbing down her knee.” Parents should be mindful of those things.

Also, we encourage parents to watch for the level of pain after dance. We usually advise that a low level of pain is acceptable some of the time. That’s a 4 or 5 out of 10, on occasion, and is often a symptom of soreness, as opposed to something that is more persistent.

Remember, most sports are seasonal, but dance is a year-round pursuit with little downtime. Thus, my mentality has to change when treating a dancer.

Cutting Sugar

Most parents at some point have uttered the phrase, “My child has such a sweet tooth!” And yet few parents do anything about it.  We hear time and again that children have too much sugar in their diets. Cutting sugar isn’t a simple task. But it’s an important one.

“One third of children in the U.S. are affected by overweight and obesity,” said Beverly Haynes, RN, nurse clinician in the Weight Management Clinic at Children’s of Alabama. “We know that this leads to a multitude of even more serious diseases such as hypertension, diabetes, heart disease, liver disease, joint problems and many more.”

One way to cut down on sugar is to reduce or eliminate the obvious offenders. Parents can easily restrict candy and products like maple syrup, honey and jellies. Eliminating sugar-sweetened drinks like sodas and fruit juices alone can make a huge impact! Consider these facts:

  • Each 12-ounce serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar and 150 calories. Sweetened drinks are the largest source of added sugar in the daily diets of U.S. children.
  • Consuming one 12-ounce sweetened soft drink per day increases a child’s risk of obesity.

But it’s important to know that many foods contain “hidden sugars.”  Products not normally considered “sweet” can have a lot of sugar in them.  Examples are peanut butter, salad dressings, and ketchup.

In addition, the carbohydrates in highly refined foods with simple sugars, such as white flour and white rice, are easily broken down and cause blood sugar levels to rise quickly.  Complex carbs, found in whole grains, on the other hand, are broken down more slowly, allowing blood sugar to rise more gradually.

According to Beverly, the best source of sugar is fruits and vegetables.  Instead of soda or juice drinks, serve low-fat milk, water or 100 percent fruit juice. A word of caution: although there’s no added sugar in 100 percent fruit juice, the calories from those natural sugars can add up. So limit juice intake to 4-6 ounces for children under 7 years old, and no more than 8-12 ounces for older kids and teens.

To find out if a food has added sugar, look at the ingredient list for sugar, corn syrup or sweetener, dextrose, fructose, honey or molasses. Avoid products that have sugar or other sweeteners high on the ingredient list.

Children’s weight management experts will never tell a patient they can’t enjoy an occasional slice of birthday cake. Occasional treats are okay. The key is that parents are aware of the amount of sugar in their children’s diet, and that they stay informed by reading the labels on foods and setting limits. Above all, it’s important for parents to be a good role model. Kids will see mom and dad’s wholesome habits and adopt them, leading to a healthier lifestyle throughout childhood and into adulthood.

Carbon Monoxide Dangers

While carbon monoxide may come to mind more frequently during winter months, it’s actually a year-round hazard. Knowing how your family can be exposed to carbon monoxide can keep them safe from this colorless, odorless, tasteless, poisonous gas.  carbonmonoxide

Carbon monoxide is produced when you burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges or furnaces.  It is one of the leading causes of poisoning deaths in the United States. Carbon monoxide poisoning accounts for approximately 40,000 to 50,000 emergency room visits and 5,000 to 6,000 deaths annually in the United States. Yet all instances of carbon poisonings are preventable.

“Carbon monoxide detectors should be installed in addition to smoke detectors. If your smoke detector goes off and there is a fire, you could be exposed to carbon monoxide. However, you can be exposed to carbon monoxide even if there isn’t a fire. That’s why it’s so important to have both a smoke and carbon monoxide detector in the home,” said Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, managing director, Regional Poison Control Center at Children’s of Alabama.

If your carbon monoxide detector goes off:

  • leave the home and immediately seek fresh air
  • call 911 for the fire department to inspect the home
  • call the Poison Control Center at 1-800-222-1222 if there are signs and symptoms of carbon monoxide exposure

The most common symptoms of carbon monoxide exposure are headache, fatigue, dizziness, weakness, nausea, vomiting, chest pain and confusion.

“One of the hallmarks of carbon monoxide exposure is multiple people sick at the same time. Unlike a virus that takes its time working through the household, carbon monoxide will affect everyone in the home at the same time.” Slattery said.

As warm weather approaches, you may already be thinking about your favorite outdoor activities. Keep in mind that you could be exposed to carbon monoxide through:

  • Generators — Don’t use a generator inside the home, garage or basement or near windows. Spring often brings severe weather to Alabama, so be cautious when using a generator during a power outage.
  • Grilling — Never burn charcoal indoors or use a portable camp stove in a garage.
  • Camping — Never use a kerosene lantern inside a tent.
  • Boating — Carbon monoxide from engine exhaust builds up inside and outside the boat in areas near exhaust vents. Swim and play away from areas where engines vent their exhaust. Dock, beach, or anchor at least 20 feet away from the nearest boat that is running a generator or engine. Exhaust from a nearby vessel can send CO into the cabin and cockpit of a boat.
  • Gasoline-powered tools — Never use gasoline-powered tools such as pressure washers and leaf blowers indoors or in a garage, carport or basement. These tools can produce significant amounts of carbon dioxide that can quickly build up to dangerous levels.

The Regional Poison Control Center at Children’s of Alabama was established in 1958. The center handles more than 50,000 poison calls annually, plus more than 60,000 follow-up calls. For more information, visit


Car Seat Safety for Every Age

Car seat safety isn’t just an area of concern just for parents of newborns. As children grow, it is important that they are in an appropriate car seat based on their size.carseatInstall

“There’s no magic one-size-fits-all car seat, so parents need to be familiar with the specific weight and
height limitations of their child’s car seat,” said Marie Crew, coordinator of Safe Kids Alabama and the Child Passenger Safety Resource Center. “A car seat keeps your child in the best seated position for a potential crash.”

Each year, thousands of children are injured or killed in car crashes. Because of children’s bone development and the size of their heads in relation to their torsos, their bodies can be easily injured in a car crash.

A car seat can:

  • hold your child securely.
  • protect your child from hitting something in the vehicle
  • absorb the force of a sudden stop
  • spread the force of an impact safely
  • prevent your child from being crushed by other passengers.

The right seat doesn’t have to be the most expensive one in the store. “When you’re researching seats, check to see what is the highest weight and height the seat can handle. Determine which model your child can use for the longest amount of time,” Crew said.

All infants and toddlers should ride in a rear-facing car seat until they are at least 2 years old or until they reach the height and weight limits of the seat. Safety experts say rear facing is the safest way for children to travel because it is the best way to prevent head and spinal cord injuries. The most common types of vehicle crashes are from the front or side. Therefore, children who ride in a rear-facing seat have the maximum protection for the head, neck and spine.

When a child has outgrown a rear-facing seat, he should transition to a forward-facing car seat with a harness and top tether until they reach the height and weight limits of the seat.


Children who have reached the height and weight limits of their forward-facing car seat should ride in a belt-positioning booster seat until a safety belt fits properly. Seat belts don’t fit children properly until they are at least 4 feet 9 inches and weigh between 80 to 100 pounds, usually between 8 and 12 years old. With a booster seat, the lap belt should fit low across the child’s hips, and the shoulder belt should fit across the shoulder. Children seated in a booster seat in the back seat of the car are 45 percent less likely to be injured in a crash than children using a seat belt alone.

The safest place for all children under the age of 13 is in the back seat of the car.

Parents and other adult drivers can set a good example by buckling up for every single car ride. When children see you use seat belts, you are helping develop lifelong safety habits.

For more child passenger safety tips,


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